Provider Demographics
NPI:1144998261
Name:MANASAN, JOHNAL MIGUEL (RN)
Entity type:Individual
Prefix:
First Name:JOHNAL
Middle Name:MIGUEL
Last Name:MANASAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:MIGUEL
Other - Last Name:MANASAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1689 ROSEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-2561
Mailing Address - Country:US
Mailing Address - Phone:559-410-1100
Mailing Address - Fax:
Practice Address - Street 1:3100 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3239
Practice Address - Country:US
Practice Address - Phone:800-607-6377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95039843163W00000X
CA95002272367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse